Nodular Fasciitis of the Carpus Mimicking Metastasis in a Multi-cancer Survivor

Nodular fasciitis is a benign reactive fibroproliferative lesion that is exceedingly rare within the wrist and hand, particularly when involving bone. Its rapid growth and clinical presentation can often mimic sarcomas or metastatic disease, creating a significant diagnostic challenge. We report the case of a 59-year-old male patient with a history of multiple malignancies who presented with a rapidly enlarging dorsal wrist mass. Advanced imaging revealed a large lesion eroding the carpus, raising significant concern for metastasis. However, histopathologic evaluation confirmed nodular fasciitis. The mass was excised en bloc without complex reconstruction. At the one-year follow-up, the patient remained asymptomatic with no clinical or radiographic evidence of recurrence and maintained excellent wrist function. This case highlights a rare anatomic location of nodular fasciitis and illustrates that it can mimic aggressive malignancy, particularly in cancer survivors. It further demonstrates that even with significant bony erosion, surgical excision without complex reconstruction can yield excellent functional outcomes.